Role Of Angiotensin-converting Enzyme Inhibitors Research Articles

2923: Role of ACE Inhibitors in Genito-urinary toxicity following Curative Radiotherapy for Bladder Cancer

2923: Role of ACE Inhibitors in Genito-urinary toxicity following Curative Radiotherapy for Bladder Cancer

The Potential Role of Angiotensin-Converting Enzyme Inhibitors and Beta-Blockers in Reducing Pneumonia Severity in Older Adults.

Background Understanding the impact of pharmacological therapy on pneumonia severity is crucial for effective clinical management. The impact of angiotensin-converting enzyme inhibitors (ACEis) and beta-blockers (BBs) on pneumonia severity remains unknown, warranting further investigation. Methodology This retrospective study examined the hospital records of inpatients (≥75 years) admitted with community-acquired pneumonia in 2021. Pneumonia severity associated with the use of pre-established ACEi and BB therapy was documented using CURB-65 (confusion, uraemia, respiratory rate, blood pressure, age ≥65 years) and pneumonia severity index (PSI) scores. Descriptive statistics and multivariable linear regression were used to analyse differences across BB therapy, ACEi therapy, their combination, or neither (control group). Results A total of 803 patient records were examined, of whom 382 (47.6%) were male and 421 (52.4%) were female. Sample sizes for each group were as follows: control (n = 492), BB only (n = 185), ACEi only (n = 68), and BB + ACEi (n = 58). Distribution of aspiration pneumonia (AP) versus non-AP for each group, respectively, was control (21.1% vs. 78.9%), BB only (9.7% vs. 90.3%), ACEi only (7.3% vs. 92.7%), and ACEi + BB (12.1% vs. 87.9%). No significant differences in PSI and CURB-65 scores were found between intervention groups even after controlling for patient characteristics and irrespective of AP or non-AP aetiology. Patients with AP had significantly higher CURB-65 (p = 0.026) and PSI scores (p = 0.044) compared to those with non-AP. Conclusions Pre-prescribed ACEi or BB therapy did not appear to be associated with differences in pneumonia severity. There were no differences in pneumonia severity scores with ACEi and BB monotherapy or combined ACEi and BB therapy.

Efficacy of Angiotensin-Converting Enzyme Inhibitors in Coronary Microvascular Dysfunction: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Coronary microvascular dysfunction (CMD) is becoming increasingly recognized as an important contributor to the development of ischemic heart diseases. Without obstructive coronary artery disease, the physiological function of the coronary microcirculation can be altered by structural, functional, and molecular factors, leading to myocardial ischemia. CMD can significantly impact the quality of life and prognosis and imposes a huge financial burden on healthcare systems and people. This meta-analysis aims to investigate the efficacy of angiotensin-converting enzyme inhibitors (ACEIs) for treating CMD. A systematic literature review identified randomized controlled trials (RCTs) comparing ACEIs with placebo in CMD patients. Review Manager, 5.3 for Windows, was utilized. Using the Mantel-Haenszel (M-H) method, improvement in coronary flow reserve (CFR) and systolic blood pressure events was pooled as mean difference (MD) in a meta-analysis model with a fixed effect model, whereas the number of chest pain episodes was pooled as MD with a random effect model. Five randomized controlled trials involving 209 patients were included in the analysis. The analysis demonstrated a statistically significant improvement in CFR in the ACEIs group compared to the placebo group (MD -0.3, 95% CI -0.61 to 0.01, P = 0.05). However, there was no significant difference in the number of chest pain episodes between the ACEIs and placebo groups (MD 1.79, 95% CI -3.99 to 7.58, P = 0.54). Similarly, no significant difference in blood pressure change was observed between the two groups (MD 4.02, 95% CI -3.25 to 11.28, P = 0.28). In conclusion, the appropriate treatment for CMD is a source of contention because adequate data is lacking. Our findings suggest that ACEIs may have a positive effect on improving CFR in patients with microvascular angina. However, ACEIs did not demonstrate a significant impact on the number of chest pain episodes or systolic blood pressure in this patient population. Further research, including RCTs with larger sample sizes and longer follow-up durations, is warranted to provide more conclusive evidence on the role of ACEIs in CMD management.

Takotsubo syndrome: unravelling the enigma of the broken heart syndrome?-a narrative review.

Takotsubo syndrome (TTS) is a condition characterized by transient ventricular regional wall motion abnormalities, without causative coronary artery disease, typically triggered by emotional or physical stress. TTS is more common in post-menopausal women, closely resembling acute coronary syndrome (ACS) in its clinical presentation, with multiple proposed underlying pathophysiological mechanisms and no evidence-based treatments. This review aims to provide a comprehensive summary of the latest research, encompassing the pathophysiology, diagnostic findings, prognosis, and treatment options for TTS patients. Relevant literature from 1990 to June 2023 on TTS epidemiology, physiopathology, diagnosis, clinical manifestations, treatment, and prognosis was retrieved through PubMed research. Only English publications were included. TTS is an increasingly recognized cardiovascular disorder, a significant release of catecholamines is thought to be a key contributing element, yet its exact mechanism remains unclear. Notably, TTS poses significant short and long-term risks akin to ACS. Initial treatment should focus on ruling out ACS and providing standard care for subsequent left ventricular dysfunction and complications. Research hints at a potential role for Angiotensin-converting enzyme inhibitors and Angiotensin II receptor blockers in improving long-term prognosis in TTS patients. Significant knowledge gaps still exist in our understanding of the pathophysiology, treatment options, and areas for improvement in diagnosing and prognosticating this intriguing condition. Further research is therefore needed.

The Pivotal Role of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers in Hypertension Management and Cardiovascular and Renal Protection: A Critical Appraisal and Comparison of International Guidelines.

Arterial hypertension is the main preventable cause of premature mortality worldwide. Across Latin America, hypertension has an estimated prevalence of 25.5-52.5%, although many hypertensive patients remain untreated. Appropriate treatment, started early and continued for the remaining lifespan, significantly reduces the risk of complications and mortality. All international and most regional guidelines emphasize a central role for renin-angiotensin-aldosterone system inhibitors (RAASis) in antihypertensive treatment. The two main RAASi options are angiotensin-converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs). Although equivalent in terms of blood pressure reduction, ACEis are preferably recommended by some guidelines to manage other cardiovascular comorbidities, with ARBs considered as an alternative when ACEis are not tolerated. This review summarizes the differences between ACEis and ARBs and their place in the international guidelines. It provides a critical appraisal of the guidelines based on available evidence from randomized controlled trials (RCTs) and meta-analyses, especially considering that hypertensive patients in daily practice often have other comorbidities. The observed differences in cardiovascular and renal outcomes in RCTs may be attributed to the different mechanisms of action of ACEis and ARBs, including increased bradykinin levels, potentiated bradykinin response, and stimulated nitric oxide production with ACEis. It may therefore be appropriate to consider ACEis and ARBs as different antihypertensive drugs classes within the same RAASi group. Although guideline recommendations only differentiate between ACEis and ARBs in patients with cardiovascular comorbidities, clinical evidence suggests that ACEis provide benefits in many hypertensive patients, as well as those with other cardiovascular conditions.

A Study of Prognosis and Outcome of COVID-19-Infected Hypertensive Patients on Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers

Abstract Background and Objective: COVID-19 is a pandemic caused by the virus severe acute respiratory syndrome coronavirus-2. The mortality in susceptible populations with chronic pulmonary disease, cardiac ailments, kidney disease, diabetes, and hypertension is high. While the role of angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARBs) in contracting novel coronavirus has clearly been elucidated, there remains uncertainty in the prognosis and outcome of COVID-19-infected patients on ACE inhibitors and ARBs. The current study was conducted to find whether these medications bore any significance in the prognosis and outcome of hypertensive patients with COVID-19 infection. Materials and Methods: This is a retrospective cohort study. We studied 96-admitted hypertensive patients with pneumonia due to COVID-19 in Krishna Rajendra Hospital at Mysore during April 2021. Patients were categorized into two groups based on antihypertensive treatment: (1) Those on ACEi/ARBs (n = 33) and (2) Those on non-ACEi/ARBs (n = 66). We analyzed the parameters such as duration of hypertension, comorbidities, mode of oxygen/pressure support delivery, duration of hospital stay, and mortality among the two groups. Results: 65.6% of patients were on non-ACEi/ARBs, 10.4% on ACE inhibitors, and 24% on ARBs. Of the patients on non-ACEi/non-ARBs, 51% were on supplemental oxygen, 20.8% were on NIV, 6.3% were intubated, and 21.9% did not require oxygen. Of those on ACEi, 63.6% were on supplemental oxygen, 15.2% were on NIV, none were intubated, and 21.2% did not require oxygen. Of those on ARBs, 53.3% were on supplemental oxygen, 18.5% were on NIV, 5.4% were intubated, and 22.8% did not require oxygen. 62.5% of patients on non-ACEi/ARBs recovered, whereas 37.5% succumbed. 83.3% of patients on ACEi recovered, whereas 16.7% succumbed. 65.2% of patients on ARBs recovered, whereas 34.8% succumbed. There was no significant correlation between non-ACEi/ARBs, ACEi, and ARBs with duration of hypertension (P = 0.092), sex (P = 0.189), mode of oxygen/pressure support delivery (P = 0.313), ward/intensive care unit stay (P = 0.624), and the final outcome of the patient (P = 0.734). Conclusion: In the population studied, the use of ACEi/ARBs in COVID-positive hypertensives was not associated with adverse outcomes as compared to those on non-ACEi/non-ARBs.

Centrally Acting ACE Inhibitor Use and Physical Performance in Older Adults

BackgroundThere is conflicting evidence regarding the role of angiotensin-converting enzyme inhibitors and physical function. While some studies show improvements in muscle strength and physical function, others show no significant difference or decreased performance. This ambiguity could be due to differential effects of angiotensin-converting enzyme inhibitor subtypes which can be categorized as centrally or peripherally-acting based upon their ability to cross the blood-brain barrier.ObjectiveThe objective of this study is to compare physical performance measures among angiotensin-converting enzyme inhibitor subtype users.MethodsDesign: Cross-sectional Setting: Ambulatory Participants: Performed in 364 participants in the Health and Retirement Study cohort who were ≥ 65 years (median age (IQR) 74.00 (69–80) years. Measurements: Average difference in hand grip (kg), gait speed(m/s) and peak expiratory flow (L/min).ResultsCompared to participants on a peripherally-acting angiotensin-converting enzyme inhibitor (113 (31%)), those on a centrally-acting agent (251(69%)) had stronger grip strength 28.9 ±1.0 vs 26.3±1.0, p=.011 and higher peak expiratory flow rates 316.8±130.4 vs. 280.0±118.5, p=.011 in unadjusted analysis. After multiple adjustments the difference in PEF remained statistically significant (Estimate(CI) 26.5, 95% CI 2.24, 50.5, p = 0.032).ConclusionOur results suggest that in older adults the use of centrally-acting angiotensin-converting enzyme inhibitors compared to a peripherally acting angiotensin-converting enzyme inhibitors was associated with better lung function in older individuals.

Ace inhibitors in the treatment of arterial hypertension (literature review)

Literature data on the role of the renin-angiotensin-aldosterone system in the pathogenesis of arterial hypertension and the role of angiotensin-converting enzyme inhibitors in the treatment of hypertension have been given.The renin-angiotensin-aldosterone system is the central element in controlling the body's water-salt balance and blood pressure. The main effector link of the renin-angiotensin system is angiotensin II, which causes vasospasm, activates heart contraction, inhibits the production of bradykinin, promotes proliferation, and fibrosis of blood vessels and myocardium, and promotes the synthesis of aldosterone in the glomerular zone of the adrenal cortex.Angiotensin-converting enzyme inhibitors are the mainstay of the treatment of arterial hypertension. They contribute to the correction of hypertension, hypertrophy, remodeling of the left ventricle, endothelial dysfunction, proliferation of arterial smooth muscles, and thrombotic phenomena. The 2018 ESH/ESC guidelines state that the first-line therapy in most patients with hypertension should be a fixed combination of a renin-angiotensin system blocker and a calcium channel blocker or diuretic. Blockade of the renin-angiotensin-aldosterone system is currently considered a gold standard of antihypertensive therapy.The objective is to systematize modern literature data on the role of ACE inhibitors in the treatment of arterial hypertension. Conclusion. To date, the concept of the role of the renin-angiotensin-aldosterone system (RAАS) in the pathogenesis of arterial hypertension and the role of ACE inhibitors in the treatment of hypertension has been formulated.

Role of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in cryoballoon ablation outcomes for paroxysmal atrial fibrillation.

Cryoballoon ablation (CBA) is recommended for patients with paroxysmal atrial fibrillation (AF) refractory to antiarrhythmic drugs. However, only 80% of patients benefit from initial CBA. There is growing evidence that pretreatment with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) decreases the recurrence of AF postablation, particularly in nonparoxysmal AF undergoing radiofrequency ablation. The role of ACEIs and ARBs in patients with paroxysmal AF in CBA remains unknown. We decided to investigate the role of ACEIs and ARBs in preventing the recurrence of atrial arrhythmia (AA) following CBA for paroxysmal AF. To investigate the role of ACEIs and ARBs in preventing recurrence of AA following CBA for paroxysmal AF. We followed 103 patients (age 60.6 ± 9.1 years, 29% women) with paroxysmal AF undergoing CBA 1-year post procedure. Recurrence was assessed by documented AA on electrocardiogram or any form of long-term cardiac rhythm monitoring. A multivariable Cox proportional hazard model was used to assess if ACEI or ARB treatment predicted the risk of AA recurrence. After a 1-year follow-up, 19 (18.4%) participants developed recurrence of AA. Use of ACEI or ARB therapy was noted in the study population. Patients on ACEI/ARB had a greater prevalence of hypertension and coronary artery disease. On a multivariate model adjusted for baseline demographics and risk factors for AF, ACEI or ARB therapy did not prevent recurrence of AA following CBA (P = 0.72). Similarly, on Kaplan-Meier analysis pretreatment with ACEI/ARB did not predict the time to first recurrence of AA (P = 0.2173). In our study population, preablation treatment with an ACEI or ARB had no influence on the recurrence of AA following CBA for paroxysmal AF.

Role of angiotensin-converting enzyme inhibitors in patients with aortic stenosis

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-2 receptor blockers (ARBs) are used extensively in the treatment of arterial hypertension. There is a widespread belief that these drugs are contraindicated in patients with underlying aortic stenosis due to their vasodilatory effect, which could result in hypotension and syncope. Nonetheless, these drugs may significantly benefit such patients with their proven cardioprotective benefits and positive effects on left ventricular remodelling. Despite widespread concerns about their safety, the currently available studies do not report any significant side effects. Оn the contrary, they find improved survival rates, a reduction in adverse cardiovascular events, and a reduction in symptoms. Further clinical studies and trials are necessary to assess the safety of ACEIs in patients with hypertension and underlying aortic stenosis and their effects on cardiac function and survival.

Small animal Review

Summary: This issue's Small Animal Review features studies that seek to answer the long-standing question of the role of angiotensin-converting enzyme inhibitors in preclinical myxomatous mitral valve disease. Previous recommendations have suggested they are beneficial for use in dogs before they present with clinical signs, if cardiomegaly was present on radiographic or ultrasonographic examination. Systematic reviews and meta-analyses are considered the highest form of evidence and they can be helpful in answering questions when single trials do not have sufficient power to be conclusive.samples in measuring exposure to aromatic amines.

Analysis of factors associated with arterial stiffness in the general working-age population

Aim. To examine associations of cardio-ankle vascular index (CAVI) with classical, behavioral and social risk factors (RFs) of cardiovascular disease (CVD) in adult population.Material and methods. The study included 1365 people (women, 59%) from a representative sample aged 25-64 years (ESSE-RF), who underwent standard cardiology screening and volume sphygmography (VaSera-1500). All respondents signed an informed consent to participate in the study. The analysis included blocks of classical, social and behavioral risk factors for CVD. A linear model was used to identify associations. An error rate of <5% was considered significant.Results. Age, sex, systolic blood pressure (SBP), triglycerides were associated with higher CAVI values, and body mass index (BMI) was associated with lower values, respectively. After 45 years, a direct association with heart rate (HR) became increasingly important, while after 50 years — with diabetes and the intake of beta-blockers, while the association between diabetes and CAVI was observed only among individuals not taking angiotensin-converting enzyme (ACE) inhibitors. A direct association was found with high-sensitivity C-reactive protein (hsCRP) in men, and an inverse association with diuretics in women, respectively. A sedentary work in combination with a history of bronchitis or with positive family history for CVD showed a direct relationship, while a sufficient physical activity (PA) showed an inverse relationship with the studied indicator, but only among people with belowaverage income.Conclusion. According to the data obtained, in addition to age and sex, the following risk factors made a significant contribution to CAVI parameters in the examined population: BMI, SBP, triglycerides, diabetes, HR, intake of betablockers, diuretics, ACE inhibitors; hsCRP, PA. The unfavorable role of betablockers, high HR, diabetes, sedentary work, chronic lung pathology, hereditary burden, as well as the protective role of ACE inhibitors, diuretics and intense PA in relation to arterial stiffness in the working-age population has been shown. Additional studies are needed to determine the nature of a number of associations. The results obtained may contribute to the study of CAVI role in risk stratification and further development of methodological approaches to CVD prevention.

Renin-angiotensin system blocker and the COVID-19 aggravation in patients with hypertension, diabetes, renal failure, Cerebro-cardiovascular disease, or pulmonary disease: Report by the COVID-19 Registry Japan

BackgroundThe role of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) in the pandemic context of coronavirus disease 2019 (COVID-19) continues to be debated. Patients with hypertension, diabetes mellitus, chronic renal failure, cerebro-cardiovascular disease, or chronic obstructive pulmonary disease (COPD), who often use ACEi/ARB, may be at risk of severe COVID-19. However, there are no data available on the association of ACEi/ARB use with COVID-19 severity in this population. MethodsThis study is an observational study of patients with a positive severe acute respiratory syndrome coronavirus 2 test and inpatient treatment at a healthcare facility, using the registry information of COVIREGI-JP. Our primary outcomes were in-hospital death, ventilator support, extracorporeal membrane oxygenation support, and intensive care unit admission. Out of the 6055 patients, 1921 patients with preexisting hypertension, diabetes mellitus, chronic renal failure, cerebro-cardiovascular disease, or COPD were enrolled. ResultsFactors associated with an increased risk of the primary outcomes were aging, male sex, COPD, severe renal impairment, and diabetes mellitus. No correlations were observed with ACEi/ARB, cerebro-cardiovascular diseases, or hypertension. Associated factors in male patients were aging, renal impairment, hypertension, and diabetes. In female patients, factors associated with an increased risk were aging, ACEi/ARB, renal impairment, and diabetes, whereas hypertension was associated with a lower risk of the primary outcomes. ConclusionsIndependent factors for the primary outcomes were aging, male sex, COPD, severe renal impairment, and diabetes, but not ACEi/ARB. Based on this registry data analysis, more detailed data collection and analysis is needed with the cooperation of multiple healthcare facilities.

Role of Angiotensin-converting Enzyme Inhibitors (ACEI)/Angiotensin Receptor Blockers (ARBs) and Hydrocortisone in COVID-19 Patients Admitted to the Intensive Care Unit

Objective: The purpose of study was to assess the role of angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARBs) and hydrocortisone in patients with COVID-19 and their outcome during hospitalization.
 Materials and Methods: A clinical comparative prospective hospital-based study was conducted in the Department of Pulmonology & Intensive Care Unit (ICU) of Dow University of Medical & Health Sciences, Karachi in patients positive for COVID-19 infection during their hospitalization. A comparative analysis was performed between two groups, i) those who received an injection of hydrocortisone and ii) those who received oral ACEi/ARB. All the baselines and clinical variables were recorded in a structured questionnaire and the data were evaluated in the Statistical Package for the Social Sciences (SPSS) version 22.0. A p-value of <0.05 is considered statistically significant.
 Results: The final analysis was performed on 130 patients among them 68 patients received an injection of hydrocortisone and 62 patients received the tablet ACEi/ARB, which ever indicated. Patients who need injection hydrocortisone were older than patients who received ACEi/ARB, 58.37±15.20 and 51.01±90.22. Patients who received injection hydrocortisone were more likely to receive mechanical ventilation support as compared to other groups, 11.7% vs. 4.8%, respectively, p-value 0.02. The overall mortality rate was 10% (n = 13) in both groups in which a higher number of deaths was observed in patients who were taking ACEi/ARB as compared to patients who were receiving injection hydrocortisone, 12.9% vs. 7.3%, respectively, but it had an insignificant association, p-value 0.17.
 Conclusion: We have observed in our study that patients who received an injection of hydrocortisone had lower rates of mortality irrespective of their gender and age while patients who received ACEi/ARB during hospitalization had lower complications rate but higher mortality rates.

Angiotensin Converting Enzyme Inhibitors versus Receptor Blockers in Patients with Ventricular Tachyarrhythmias.

Data investigating the prognostic value of treatment with angiotensin converting enzyme inhibitors (ACEi) and receptor blockers (ARB) usually focusses on patients presenting with heart failure (HF) or acute myocardial infarction (AMI). However, by preventing adverse cardiac remodeling, ACEi/ARB may also decrease the risk of ventricular tachyarrhythmias and sudden cardiac death (SCD). Although ventricular tachyarrhythmias are associated with significant mortality and morbidity, only limited data are available focusing on the prognostic role of ACEi/ARB, when prescribed for secondary prevention of SCD. Therefore, this study comprehensively investigates the role of ACEi versus ARB in patients with ventricular tachyarrhythmias. A large retrospective registry was used including consecutive patients with episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2015. The primary prognostic outcome was all-cause mortality at three years, secondary endpoints comprised a composite arrhythmic endpoint (i.e., recurrences of ventricular tachyarrhythmias, ICD therapies and sudden cardiac death) and cardiac rehospitalization. A total of 1236 patients were included (15% treated with ARB and 85% with ACEi) and followed for a median of 4.0 years. At three years, ACEi and ARB were associated with comparable long-term mortality (20% vs. 17%; log rank p = 0.287; HR = 0.965; 95% CI 0.689–1.351; p = 0.835) and comparable risk of the composite arrhythmic endpoint (HR = 1.227; 95% CI 0.841–1.790; p = 0.288). In contrast, ACEi was associated with a decreased risk of cardiac rehospitalization at three years (HR = 0.690; 95% CI 0.490–0.971; p = 0.033). Within the propensity score matched cohort (i.e., 158 patients with ACEi and ARB), ACEi and ARB were associated with comparable long-term outcomes at three years. In conclusion, ACEi and ARB are associated with comparable risk of long-term outcomes in patients presenting with ventricular tachyarrhythmias.

Long-Term Persistence of Olfactory and Gustatory Disorders in COVID-19 Patients.

Smell and taste disorders are frequent symptoms during acute COVID-19 and may persist long after the resolution of the initial phase. This study aims to estimate the proportion and risk factors for smell and/or taste disorders at the onset of symptoms and their persistence after more than 6 months of follow-up in COVID-19 patients. We analyzed a prospective cohort of COVID-19 patients admitted to our institute in Marseille, France in early 2020. After being discharged from the hospital, patients with smell and/or taste disorders were contacted for a telephone interview. Logistic regression analysis was performed to determine the risk factors for smell and/or taste disorders. A total of 3,737 patients were included, of whom 1,676 reported smell and/or taste disorders at the onset of symptoms. Taste and/or smell disorders were independently associated with being younger and female, a lower likelihood of suffering from diabetes, cardiovascular diseases and cancer, a longer delay between the onset of symptoms and consultation, and non-severe forms of COVID-19 at admission. Of the 605 patients with smell and/or taste disorders who were followed-up, 154 (25.5%) reported the persistence of symptoms for more than 6 months. At the time of follow-up, being female, having a chronic respiratory disease and using angiotensin-converting enzyme inhibitors (ACEis) were factors independently associated with the persistence of smell and/or taste disorders. In conclusion, the long-term persistence of olfactory and gustative disorders is frequent among COVID-19 patients, notably affecting female patients and patients who suffered from chronic respiratory diseases before infection. The role of ACEis needs to be further evaluated in larger numbers of patients.

Abstract 14496: The Role of ACE Inhibitors and Angiotensin Receptor Blockers in Cryoballoon Ablation Outcomes for Paroxysmal Atrial Fibrillation

Background: Cryoballoon ablation (CBA) is recommended for patients with paroxysmal atrial fibrillation (AF) refractory to anti-arrhythmic drugs. However, only 70% of patients benefit from an initial CBA. There is a growing evidence that pretreatment with angiotensin converting enzyme inhibitors (ACE-I) and angiotensin receptor blocker (ARB) decreases recurrence of AF post ablation, particularly in non-paroxysmal AF undergoing radiofrequency ablation. The role of ACE-I and ARB in patients with paroxysmal AF in CBA remains unknown. We decided to investigate the role of ACE-I and ARB in preventing recurrence of atrial arrhythmias (AA) following CBA for paroxysmal AF. Methods: We followed 103 patients (Age 60.6 ± 9.1, 29% women) with paroxysmal AF undergoing CBA for one year post procedure. Recurrence was assessed by documented AA on EKG or any form of long-term cardiac rhythm monitoring. A multivariable cox proportional hazard model was used to assess if ACE-I or ARB treatment predicted risk of AA recurrence. Results: After a one year follow up, 19 (18.4%) participants developed recurrence of AA. Use of ACE-I or ARB therapy was noted in the study population. Patients on ACE-I/ARB had a greater prevalence of hypertension and coronary artery disease. On a multivariate model adjusted for baseline demographics and risk factors for AF, ACEI or ARB therapy did not prevent recurrence of AA following CBA (Table, p=0.72). Similarly, on Kaplan-Meier analysis pretreatment with ACE-I/ARB did not predict time to first recurrence of AA (Figure, p=0.2173). Conclusion: In our study population pre-ablation treatment with an ACE-I or an ARB had no influence on the recurrence of AA following CBA for paroxysmal AF.

Abstract 10482: Renin-Angiotensin-Aldosterone System Inhibition is Associated with Reduced In-Hospital Mortality in Critically Ill Covid-19 Patients with Pre-Existing Hypertension

Background: The virus responsible for COVID-19 enters human cells by binding angiotensin-converting enzyme 2. The influence of renin-angiotensin-aldosterone system (RAAS) inhibitors, including angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs), remains uncertain. Aim: To examine the role of ACEi / ARB exposure on outcomes in COVID-19 patients with pre-existing hypertension (HTN) admitted to intensive care units (ICU). Methods: The COVID-19 Critical Care Consortium is a prospective, observational cohort study of patients requiring ICU admission for active COVID-19 spanning 354 participating sites in 54 countries. Patients >18 years old with pre-existing HTN requiring antihypertensive therapy were analysed. Length of stay and in-hospital mortality to 90 days post ICU admission were analysed as time-to-event outcomes by multistate survival analysis, and the influence of ACEi / ARB use on the hazards of death and discharge by multi-state Cox proportional hazard modelling and sensitivity analysis. Results: From December 1, 2019 through December 30, 2020, 663 eligible patients were registered. Of these, 480 patients had received ACEi and / or ARB therapy (median age 65 years, 67% male) in the 2 weeks before ICU admission, while 183 had not (66 years, 61% male). Average lengths of ICU and general ward stays were longer in the ACEi / ARB than non-ACEi / ARB group (20.8 days and 6.5 days vs. 15.5 and 6.0 days, respectively). ACEi / ARB use was associated with a decreased hazard of death (HR, 0.69, 95% CI, 0.54 — 0.88) that persisted after adjusting for propensity scores (0.67, 0.53 — 0.86). Cumulative probabilities (unadjusted for baseline characteristics) for death and discharge post ICU admission are depicted in the figure for ACEi/ARB (red) and non-ACEi / ARB (blue) patients. Conclusions: In 663 critically ill COVID-19 patients with pre-existing HTN, RAAS inhibition pre-ICU admission was linked to reduced in-hospital mortality.

Possible new role for angiotensin-converting enzyme inhibitors in treating glomerulonephritis

Serum transforming growth factor-beta (TGF-beta1) production was estimated for 10 patients with essential hypertension, 12 patients with glomerulonephritis (5 hypertensive and 7 normotensive) and 10 healthy controls. The glomerulonephritis group received angiotensin-converting enzyme inhibitor captopril 25-75 mg/day for 4 weeks. Blood urea, serum creatinine, 24-hour urinary protein and serum TGF-beta1 were then re-estimated. Urea and creatinine were significantly higher in the hypertension and glomerulonephritis groups than in the controls and also higher in the glomerulonephritis group than the hypertension group. TGF-beta1 was significantly higher in the glomerulonephritis groups than in the control and hypertension groups. TGF-beta1 and 24-hour urinary protein were significantly reduced in the glomerulonephritis group.

Role of angiotensin-converting enzyme inhibitors on changes in troponin levels in breast cancer with anthracycline chemotherapy

Introduction: Breast cancer is the most common type of cancer among women throughout the world. The anthracycline is widely used in the treatments of this cancer. Although it is very effective, its usage is limited due to side effects, such as heart failure. Angiotensin-converting enzyme inhibitors (ACEi) have been reported to delay the process of left ventricular (LV) dysfunction in several clinical trials. This study assesses the role of ACEi in the alteration of troponin levels in breast cancer patients treated in anthracycline chemotherapy.Methods: This research was a clinical trial Quasi-experimental design that has a control group, whereas the treatment group is purposively determined. The treatment group received with anthracycline chemotherapy plus ACEi, and the ACEi were given before chemotherapy until to 3rd cycle of chemotherapy. Initial troponin levels of the patients were measured pre- and post-treatment, whereas the sample size was determined by calculating via the equation from 15 people each group.Results: The administering of ACEi could prevent increasing troponin levels by an average of 0.1133 ng/dl from 0.120 ± 0.077 ng/dl to 0.233 ± 0.219 ng/dl, with a p-value = 0.014. Delta Troponin's in Mann-Whitney test value has a p-value of 0.021, so it can be concluded that there is a significant difference between control and treatment group in Delta Troponin, in which the value of control has fewer number than the control treatment.Conclusion: The treatment group that received the ACEi intervention could prevent an increase of troponin levels after chemotherapy. Overall, it can be concluded that the consumption ACEi can inhibit the rise of Troponin.